Related Subjects:
Pharmacology in the Elderly
Capacity in Older Adult
Role of Urinary Catheters in the Elderly
Constipation in the Elderly
Falls
Post Falls Assessment
DNACPR in the Older Person
Treatment Escalation Plans (TEP) in the Elderly
Caring for Patients with Dementia
Surgical Liaison in Older Patients Quality & Silver Trauma (UK)
🩺 Post-Fall Assessment – Overview
⚠️ Every fall in older adults (>65) should trigger a structured post-fall assessment.
Aim: Identify underlying causes (medical, functional, environmental), assess injury, and prevent recurrence.
Assessment should be multidisciplinary and person-centred.
🔎 Step 1: Immediate Assessment
- 🩹 Check for injuries: fractures (hip, wrist, pelvis, vertebrae), head injury, soft tissue trauma.
- 💓 Vital signs: BP, HR, temperature, oxygen saturation.
- 🧠 Neurological status: consciousness, cognition, focal deficits, delirium screening.
- 🩸 Labs if indicated: FBC, U&E, glucose, TFTs, vitamin D, calcium, renal function, coagulation if on anticoagulants.
- 🦴 Imaging if needed: X-ray for suspected fracture, CT head if head injury, anticoagulated, or neuro signs. 🧠
- 🚨 Assess for acute red flags: syncope, ACS, arrhythmia, stroke, infection.
🔎 Step 2: Detailed History
- 🕒 Circumstances: time, location, activity, environmental hazards.
- ⚡ Prodrome: dizziness, palpitations, chest pain, vertigo, visual changes.
- 🧠 Loss of consciousness: duration, post-ictal confusion, incontinence, tongue biting (seizure?).
- 💊 Medication review: sedatives, hypnotics, antidepressants, antihypertensives, diuretics, polypharmacy, recent changes.
- 🏡 Home environment: lighting, flooring, stairs, trip hazards, footwear.
- 🚶 Functional baseline: gait, balance, walking aids, previous falls.
- 🥤 Nutrition & hydration: recent intake, dehydration risk, malnutrition.
🔎 Step 3: Physical Examination
- 🦵 Musculoskeletal: strength, joint range, balance, gait, sarcopenia signs.
- 💓 Cardiovascular: pulse, BP lying/standing (orthostatic hypotension), arrhythmias, murmurs.
- 🧠 Neurological: cognition, cranial nerves, cerebellar testing, peripheral neuropathy.
- 👁️👂 Sensory: vision, hearing, proprioception, vestibular function.
- 🩹 Skin: bruises, pressure injury risk, nutritional status.
🔎 Step 4: Risk Stratification & Investigations
- 🚶 Functional tests: Timed Up and Go (TUG), gait analysis, balance tests.
- 🧠 Cognitive screen: MMSE, MoCA, delirium assessment if acute change.
- 📊 Lab investigations: as guided by comorbidities or suspicion of metabolic/electrolyte causes.
- 🛏️ Falls Risk Assessment Tools: FRAT (community), STRATIFY (inpatient), interpreted with clinical judgment.
- 🦴 Imaging: X-ray, CT head, echocardiography if cardiac cause suspected.
🛠️ Step 5: Management & Prevention Planning
- 🔍 Treat reversible causes: infection, anaemia, dehydration, electrolyte disturbances, acute illness.
- 💊 Review and adjust medications (stop/reduce high-risk drugs, polypharmacy).
- 🏃 Exercise: individualized strength and balance training (Otago, Tai Chi, physiotherapy).
- 👩🔧 Home assessment: remove trip hazards, install rails, improve lighting, review footwear.
- 🦴 Bone health: FRAX, DEXA, bisphosphonates ± vitamin D/calcium for osteoporosis risk.
- 🥤 Nutrition & hydration: optimize intake, treat malnutrition, ensure vitamin D sufficiency.
- 👥 Multidisciplinary involvement: GP/geriatrician, physiotherapist, occupational therapist, pharmacist, social services.
- 📝 Document a personalized falls care plan with follow-up, reassessment, and patient education.
🚨 Red Flags Requiring Urgent Action
- 💔 Chest pain, palpitations, exertional syncope → arrhythmia/ACS.
- 🧠 Acute neurological deficit → stroke, seizure, spinal cord lesion.
- 🦴 Severe pain or deformity → fracture (hip, pelvis, vertebrae).
- 🩸 Head injury in anticoagulated patients → urgent CT head.
- ⚡ Recurrent unexplained falls → urgent cardiac/neurological review.
🎯 Key Takeaways
- Falls are multifactorial and often preventable with systematic assessment and intervention.
- Post-fall assessment should combine history, physical exam, functional assessment, lab/investigations, and environmental review.
- Management should be multidisciplinary, including exercise, medication optimization, home safety, and bone health.
- Document an individualized falls care plan with follow-up. 📝
📚 References (UK / NICE Compliant)
